2012 atlas of NEURORADIOLOGY 200 common cases AMMAR HAOUIMI 2

AtlasOf
Neuroradiology

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ISBN:978-1-4269-6968-3(sc)
ISBN:978-1-4269-6971-3(e)


LibraryofCongressControlNumber:2011909194

Traffordrev.01/25/2012
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Contents
Brain
VASCULARandTRAUMATIC
Infectionand
InflammatoryDiseases
DegenerativeDiseases
Neoplasms
Malformations,Phacomatosis
and
Granulomatosis
SpineandSpinalCord
TumorsofSpine
InfectionofSpine
DegenerativeandTrauma.ofspine
MalformationsofSpine
Miscellaneous







AtlasofNeuroradiology
200Cases(COMMONDISEASES)
–––––––––––––––––––

AmmarHAOUIMI
DIS,DUCT,DURP,EDUS(France)
ConsultantRadiologist
Es-SalemImagingCenter
Batna,Algeria


InColloborationwith


RabahBOUGUELAA
DIS(France)

ConsultantRadiologist
Es-SalemImagingCenter
Batna,Algeria







To

My wife and children for understanding and tolering, the countless
hourswhenIwasbehindthecomputerworkingonthisbook.

Preface
––––––––––––––––––––––

The invention of computed tomography and magnetic resonance imaging has
completelychangedthemorphologicalandfunctionalexplorationofthenervous
system and therefore has a very precise approach to diagnosis of the most
neurologicaldiseases.
The progress in neuroradiological imaging need intensive further training to
enableallradiologistsandclinicians,theoptimaluseofthesetechniques.
The topics covered in Atlas of Neuroradiology represent the common and
important diseases encountered in neuroradiology. The material presented for
each case provides a thorough and comprehensive description of the disease
entityenablingtheradiologistorthecliniciantodevelopaclearconceptofthe
entity through the different imaging modalities that are present. In this book, I
attempt,alleasttofillasmallgapofknowledgeinneuroradiologyandhopethat
will be useful for residents in radiology, radiologists, neurologists and
neurosurgeons.

AmmarHAOUIMI



Acknowledgements
––––––––––––––––––––––

I would like to acknowledge my teachers, Abdelkrim Berrah Professor and
chairman,DepartmentofMedicineatBabEl-ouedUniversityHospital,Algiers,
and Professor Moulay Ahmed Meziane, Head Section of Thoracic Imaging,
Department of Diagnostic Radiology, Cleveland Clinic Fondation Ohio, USA

and Professor Mosleh Al-Raddadi, Head of Radiology Department at King
Fahad University Hospital Al Madinah, KSA, for their support and
encouragementtocontinuetogrow.
I am grateful for the support and friendship of my colleagues Drs Gamal
Hassan, Abdullah Al-Taifi, Ridha Okbi, Abdullah Dardiri, Hussain Shahid,
Mohammed Bediaf, Djamel Bourenane, Mohammed Said Gouhiri, Djamel
Ouslimane, Saadeddine Yassine, Abdelkader Nashed, Abdelwahab M Gabal,
Aftab Ahmed Shaikh, Nacer Kernane, Amrane Mohammedi, Mourad Chirou,
AbderrahmaneBennouar,FouadAthmani,RabahGourab,yasmineBala,Soraya
Benali, Souhil Abida, Farid Abed. Kamel Dahmane, Louardi Mohammedi,
ToufikNiaandMahfouthAbdmeziem.
I want to thank my family especially my parents, parents in law and my
brothersNacer,Abdelkader,AhmedandAbdellatiffortheirloveandsupport.
ToMr.AhmedZerguiHeadofCIDISCompany.
IwouldliketothankalsoallstaffworkinginourEs-SalemImagingCenter,
SamiaHocine,AChinaz,SihamMekaddem,RaniaLombarkia,SamiaGhenai,
Nasereddine Benamor, M’hammed Bouguelaa, Ayachi Nezzar, Zoheir Mellah,
HichamKadri,MustaphaBenguiba,MustaphaAoura.
Finally, I would like to express my gratitude to Mr Oliver Mitchell,
Supervisor Publishing Team and Mr. Dennis Taylor Publishing Services
AssociatesatTraffordPublishing(Bloomington,USA).


––––––––––––––––––––––


BRAIN

VASCULARandTRAUMATIC



Case1
ClinicalPresentation
A 49 year-old female patient with new onset of nausea, vomiting, mild left
weakness,rightfacialnumbness,vertigo,andataxia.


RadiologicalFindings

A

B

C


MRScanofbrainaxialFLAIR(A),andT2(B)andsagittalT2(C)of
spineshowafocalhighsignalintensityareaoftheleftmedulla.Noother
abnormality of the cerebellar hemispheres or the spinal cord. This is
consistentwithanacuteinfarctinthePICAdistribution.

Diagnosis:WallenbergSyndrome


Case2
ClinicalPresentation
An86year-oldfemalepatientpresentinganacutedizziness,vertigo,dysarthria,
the2ndnonenhancedCTScan(C,D)wasperformed48hourslateraftersudden
lossofconsiousness,weaknessoflimbsandblindness.


RadiologicalFindings

A

B

C

D


Nonenhanced brain CT Scan: The first brain CT Scan(A, B) done few
hoursaftertheacuteonsetshowsnormalsizeanddensityofthebrainstem
andbothcerebellarhemispheres.ThesecondCTScan(C,D)done48hours
later shows an enlarged brainstem with large central low-density area


consistingwithbrainsteminfarction.

Diagnosis:BrainstemInfarction


Case3
ClinicalPresentation
A65year-oldfemalepatientpresentedwithlefthemiplegia.


RadiologicalFindings

A

B

C

D


BrainMR,non-enhancedsagittalT1(A),axialFLAIR(B),coronalT2
(C) and MRA-3D-TOF (D) showing a low-T1 and high-FLAIR and T2
lesioninvolvingtherightanterolateralaspectofthepons.TheMRAshows
completethrombosisoftherightvertebralartery.




Diagnosis:BrainstemInfarction

Case4
ClinicalPresentation
An86year-oldmalepatientwithacutediminutionofthevision.


RadiologicalFindings

A



B

C



D


PlainbrainCTScanrevealsalargelow-densityareaintherighttemporooccipital region in the distribution of the posterior cerebral artery (PCA)
territory with mass effect on the adjacent temporal horn. No other
abnormality.





Diagnosis:PCATerritoryInfarction

Case5
ClinicalPresentation
A64year-oldfemalediabeticandhypertensivepatientwithoneweekhistoryof
temporo-spatialdisorientation,headachesanddrowsiness.


RadiologicalFindings

A

B

C

D


PlainbrainCTScanshowinglargelow-attenuationareasinvolving both
gray and white matter of the cerebellar hemispheres and occipital regions
withobliterationofthecerebellarandoccipitalsulciandmasseffectonthe
4thventricle.Notecalcificationoftherightvertebralartery(imageA).




Diagnosis:Vertebro-basilarTerritoryInfarction

Case6
ClinicalPresentation
A63year-oldmalepatient,presentedwithrighthemiparesis.


RadiologicalFindings

A

B


Nonenhanced brain CT Scan (A, B) demonstrates a large low-density
area within the distribution of the superficial territory of the left middle
cerebralartery(MCA)withlossofthegray-whitematterdifferentiationand
adjacent sulcal effacement. No significant ventricular compression or
midlineshift.








Diagnosis:LeftMCAInfarction


Case7
ClinicalPresentation

A 57 year-old male patient fell while sking 2 days ago and developed acute
visualdeteriorationwithlefthemiplegia.


RadiologicalFindings

A

B

C

D


Plain CT Scan reveals a large low-attenuation area involving the right
middle cerebral artery (MCA) territory with dense MCA, containing
hyperdenseareas(hemorrhagictransformation)withsulcaleffacementand
mildmasseffectontheadjacentlateralventricle.




Diagnosis:HemorrhagicTransformationinAcuteMCAInfarct


Case8
ClinicalPresentation
A 47 male patient with no particular past-history, presenting a sudden left
hemiplegia.

RadiologicalFindings

A



B

C



D


ThefirstCT(A)showsahyperattenuatedlinearvascularstructureinthe
right temporal region (hyperdense MCA sign), representing thrombus
formation within the vessel (early CT sign of ischemia). The second CT
(B, C, D) done three days later shows a large low density area in the
distribution of the MCA territory, containing hyperdense areas


(hemorrhagictransformationofanischemicinfarct).

D



F



E

G


…continued, MR Scan (done four days later) sagittal T1 (D), axial
FLAIR (E), coronal T2 (F) and MRA 3D-TOF (I) images show the
extensionoftheinfarctintherightMCAterritoryasalargeareaoflow-T1
and high-T2 and FLAIR signal intensity, containing area of hemorrhage
drawing the lentiform nucleus. The MRA shows complete thrombosis of
the right internal carotid artery (ICA) and partial of M1 segment of
MCA,whichissuppliedbytherightanteriorandposteriorcommunicating
arteries.